California's New Medical Care Law and Program

Abstract

Jacobus tenBrock* "Every county and every city and county shall relieve and support all incompetent, poor, indigent persons and those incapacitated by age, disease, or accident, lawfully resident therein. ... "I "[T]he boards of supervisors in each county may provide... medical and dental care and health services and supplies to persons in need thereof who are unable to provide the same for themselves, and for these purposes may levy the necessary taxes. Each county may... provide the means to meet promptly and adequately the health needs of the indigent sick, the aged, and the poor, for the better prevention of serious illness and incapacity, to the end that such persons will not become public charges at the greater expense of those resources set aside for the public health and welfare." 2 These sections, currently in the California Welfare and Institutions Code, embody traditional American policy: local responsibility for the care of the poor and medical care as a recognized welfare need.' Notwithstanding, state government support of medical care programs in California goes back as far as state government. It began in 1850-53 with a whole series of measures instituting a system of state hospitals, 4 investing public officials with quarantine and other public health powers, 5 providing a compulsory prepaid hospitalization plan for immigrants by sea 0 and programs of direct relief and medical care for overland immigrants. 7 t For invaluable assistance in the preparation of this article, the author is indebted to

The Demise of Community Responsibility: Unintended Consequences of Coverage Expansions on California Public Hospitals

“…At times, the sick in San Francisco were simply housed in abandoned ships anchored in the bay (Goldmann 1945). Nonetheless, the California constitution and subsequent acts by the legislature specifically rejected the adoption of English poor laws as the foundation of public welfare provision (tenBroek 1957(tenBroek , 1958. Indeed, early state policy makers generally failed to assign the duty to care for the indigent to any specific level of government while over time providing ever more expansive, discretionary, and permissive grants of authority to local governments to fill this role, particularly with regard to medical care (Carey 1973;tenBroek 1957).…”

“…Overwhelmed by the more than 500 ships that made port in San Francisco in 1850 alone, both national and state governments established various hospitals whose services were supplemented by contractual arrangement with private doctors (Cahn and Bary 1936;tenBroek 1958). However, the state soon abandoned the direct provision of care except for the mentally ill (Cahn and Bary 1936).…”

“…Shared-governance arrangements require two willing partners, and the national government found that partner in the State of California, which took a leading role in the expansion of medical care for its residents. Particularly after the Social Security Act amendments in the 1950s, state policy makers implemented available programs, at times even exceeding the eligibility limits written into national law (Brown, Brubaker, and Lovell 1966;tenBroek 1958). Most prominent, California established the Public Assistance Medical Care Program in the late 1950s to take full advantage of national matching funds under the Social Security Act, which extended coverage for categorically linked individuals, that is, those receiving benefits under the Social Security Act, such as children, the blind, and the disabled (Greenfield 1959(Greenfield , 1970Shonick and Roemer 1983;Workman 1977).…”